Healthcare Provider Details

I. General information

NPI: 1083812044
Provider Name (Legal Business Name): JUNE MARY ROMAN MSN, RN, PMHCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4508 CHESTNUT ST
PHILADELPHIA PA
19139-3608
US

IV. Provider business mailing address

272 SHADELAND AVE
DREXEL HILL PA
19026-2120
US

V. Phone/Fax

Practice location:
  • Phone: 267-787-8245
  • Fax:
Mailing address:
  • Phone: 610-622-4045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN172769L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: